Operational Medicine Medical Education and Training

Care of the Newborn

Dry the Baby

Immediately after delivery, the baby should be dried. Ideally, this is with a warm, soft towel, but don't delay in drying the baby while searching for a warm, soft towel.

Any dry, absorbing material will work well for this purpose. This would include:

  • Shirts

  • T-shirts

  • Gloves

  • Jackets

  • Socks

  • Battle dressings

Replace the Wet Towels

Babies can lose a tremendous amount of heat very quickly, particularly if they are wet. By removing the wet towels and replacing them with dry towels, you will reduce this heat loss.

Babies, during the first few hours of life, have some difficulty maintaining their body heat and may develop hypothermia if not attended to carefully. This is particularly true of premature infants.

Newborn Airway

Care of the Newborn

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Position the Baby

Babies should be kept on their backs or tilted to the side, but not on their stomachs.

The orientation of the head relative to the body is important for breathing. In adults, this orientation is not usually crucial; adults tolerate a relatively wide range of head positioning without compromising their airway. Not so with newborns who have a relatively narrow range of head positioning that will permit air to move unimpeded through the trachea.

The optimal position for the baby is with the head neither markedly flexed against the chest, nor extended with the chin up in the air. Instead, the head should be in a "military" attitude, looking straight up.

Position the baby on its' back with the head looking straight up. This will usually provide for good airflow.

If there is any airway obstruction, make small adjustments to the head position to try to straighten the trachea and eliminate the obstruction.

Evaluate the Baby

Evaluate the baby for breathing, color and heart rate. If the baby is not breathing well or is depressed, additional drying with a towel may provide enough tactile stimulation to cause the baby to gasp and recover.

Babies are not slapped on their buttocks for this purpose, although flicking the soles of the feet with a thumb and forefinger can provide enough noxious stimulation.

Suction the Airway

When  babies are born, they need to clear the mucous and amniotic fluid from their lungs. Several natural mechanisms help with this:

  • As the fetal chest passes through the birth canal it is compressed, squeezing excess fluid out of the lungs prior to the baby taking its' first breath. This is noticed most often after the fetal head is delivered but prior to delivery of the shoulders. After several seconds in this "partly delivered" position, fluid can be seen streaming out of the baby's nose and mouth.

  • After birth, babies cough, sputter and sneeze, mobilizing additional fluid that may be in their lungs.

  • After birth, babies cry loudly and repeatedly, clearing fluid and opening air sacs in the process. Crying is a reassuring event and does not indicate distress.

  • Newborn grunting actions may further mobilize fluid, in addition to opening the air sacs in the lungs.

While babies will, for the most part, bring the amniotic fluid out of the lungs on their own, they may need some assistance in clearing their airway of the mobilized fluid. This will require suctioning.

Bulb syringes are commonly used for this purpose, suctioning both the nose and mouth of the baby. If a bulb syringe is not available, any suction type device may be used, including a hypodermic syringe without the needle.

If no suction device is available, keep the baby in a slight Trendelenburg position (head slightly lower than the feet) and turn the baby to its' side to allow the fluids to drain out by gravity.

Continue to the PowerPoint Lecture...

From:

Operational Obstetrics & Gynecology
2nd Edition
NAVMEDPUB 6300-2C

Bureau of Medicine and Surgery
Department of the Navy

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